Workers' Compensation Safety Board of Nova Scotia

Tiered Services Forms

WCB Online is available for tiered service providers to submit forms, reports, and invoices. You can start drafts, collaborate on forms, and print copies for your records.

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Clinics using WCB Online

There are two ways to submit forms through WCB Online: As a web-based form, or as submitted PDF through secure messaging.

These forms are available as web-based online forms:

  • Initial Assessment – Form B
  • Progress Report – Form C
  • Physical Abilities – Form E
  • Assistive Devices Request
  • Tier 2 Assessment Report
  • Progress Report (Tier 2 & Tier 3)
  • Physical Abilities Report (Tier 2 & Tier 3)
  • Tier 2 Discharge Report

Complete and submit all other forms, including Form A - Intake Report, through WCB Online as an attached PDF through secure messaging.
Note: You will need the worker’s claim number and health card number to submit forms through WCB Online.

For more information, log in to WCB Online, talk to your clinic’s WCB Online account administrator or check out the WCB Online Services User Guide for tiered service providers.

Out of Province Clinics

If you are an out of province clinic, use our downloadable PDF forms.

Instructions:

  1. Save the form 
  2. Type the information required
  3. Print
  4. Sign
  5. Fax to 902-491-8001

IMPORTANT: Please ensure the claim number is on each page submitted to the WCB.

Reference: Work Capabilities Definitions

Tier 1 Forms

Form A - Intake Report

Form B - Initial Assessment

Form C - Progress Report

Form E - Physical Abilities Report

Additional Information

Service Provider Incident Form

Incident Investigation Form

Orebro Activity Screen Questionnaire

Other Forms - All Tiers

Release of Information

FCE Expectation Management Note

Case Conference Template

Tier 2 Assessment and Services Referral Form